Cost analysis of utilising wound edge protector in open appendicectomy to prevent surgical site infection

BACKGROUND: The rate of surgical site infection (SSI) differ with variable nature with appendicitis with a global incidence of up to 11%. Several randomised trials describe a significant reduction in incisional SSI using wound edge protectors (WEP), mainly in elective procedures. This study was designed to analyse WEP use in emergency open appendicectomy. METHOD: This randomised controlled trial enrolled 200 patients who underwent emergency open appendicectomy. Permuted block randomisation was used to assign subjects to either mechanical retraction or double ring WEP. The primary endpoints were SSI rates and cost analysis between the methods. RESULTS: The incidence of SSI was similar, n = 7 (7.4%) in the control group and n = 8 (8.4%) in the WEP group, and demonstrates no statistically significant difference (p > 0.05). Cost analysis showed a statistically significant (p < 0.001) higher total cost in the WEP group, MYR 456.00 (414.75, 520.00) as compared to the control group, MYR 296.00 (296.00, 300.00). However, the median cost of managing patients complicated with SSI was significantly lower at MYR 750.50 (558.75, 946.50) in the WEP group when compared to the control group MYR 1453.00 (1119.00, 2592.00) (p = 0.008). CONCLUSION: The use of WEP does not reduce the incisional SSI rate, and it is not cost-effective for application in all open appendicectomies. However, when faced with incisional SSI, the use of WEP had a significantly lower cost in incisional SSI management. Selective WEP use is economical in clinically suspected perforated appendicitis when laparoscopic appendicectomy approach is unsuitable.